Future Directions and Unmet Needs for Anti-CD20 Therapy in MS Care

As anti-CD20 therapies become entrenched in the treatment paradigm for multiple sclerosis (MS), questions about their long-term use, sequencing, and broader impact on patient care are moving to the forefront. These agents have transformed outcomes for many individuals with MS, reducing relapses, limiting MRI lesion formation, and improving functional trajectories while often being well tolerated. At the same time, their widespread adoption has prompted clinicians to consider how best to use them across the lifespan, particularly as patients remain on therapy for many years.

In this episode, Mitzi Joi Williams, MD, the founder and chief executive officer of Joi Life Wellness Group Multiple Sclerosis Center, reflects on how anti-CD20 therapies have revolutionized MS management and outlines key areas of ongoing inquiry. She notes that many clinicians now use these agents as first-line options, and that emerging real-world experience is raising important questions about when and how to adjust treatment over time. For patients who have been on anti-CD20 therapy for 8 to 10 years and are developing infections as they age, Williams highlights the need to better understand strategies such as extended-interval dosing, dose modification, or de-escalation to moderate-efficacy therapies.

Williams also discusses research directions and unmet needs that she believes will shape the future of B-cell–directed therapy in MS. She points to secondary progressive disease and progressive phenotypes as major areas of interest, including whether a finite course of B-cell therapy followed by agents with central mechanisms may offer benefits. Additionally, she emphasizes that advances in relapse control now allow greater attention to lifestyle modification and underscores ongoing gaps in evidence. These questions, she notes, will be critical to optimizing anti-CD20–based care on both individual and global scales.